Provider Demographics
NPI:1659063741
Name:PADILLA, ANDRES ULISES
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:ULISES
Last Name:PADILLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 HILLSIDE ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02120-2973
Mailing Address - Country:US
Mailing Address - Phone:857-891-9728
Mailing Address - Fax:
Practice Address - Street 1:252 JAVA ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5424
Practice Address - Country:US
Practice Address - Phone:857-891-9728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor